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r� . FOR OFFICE g'SES • FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. �_7-.�7 t ---------- ----- ---- ----------- --------- --- [Complete in Triplicate] - ---.--- f Ems_ ---------------------------------- - -- -------- ------ Date Issued_l/= 3 ----- _--------------- This Permit Expires 1 Year From Date Issued w Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. e in compliance with County Ordinance No. 549 and existing Rules and Regulations: This application is mad __ .. .. .....�.d- ` } ---- Y f - ------- -CENSUS TRACT------ ---------- , -JOB ADDRESS/LOCT ON. ___ .-, 'p -� --------------------------------- 0 _ - Phone 4`77-_173 Owner's Address.Name----------- C ----- - "r Zip r, License one._ Contractor's Name-__.___..-;----___. Installation will:serve; Residence Apartment House.❑ Commercial ❑ Trailer Court s + Motel ❑ Other -- --- -------- { --------- r Nukmber of Iiving'unitsy-!,- Number of bedrooms --3` Garb g GrinderLot Size ._ -l- ---_----- - 9 4 ------Pnvat Water Supply: Public System and name-". --------- • '----�' ., --- - ,.:_-- -- ------=-------------- - l Private i Character of soil to a depth of 3 feet: Sand "Sint Ey\Clay E] � Peat El Sandy Loam [I Clay Loam ❑ 4 -� Hardpan [) Adobe Fill Material_---------If yes, e--------------------' l (P`1ot plan, showing size of loft, location of system tem in relation to wells, buildings, etc.trust be placed on reverse side.) NEW INSTALLATION: '-(No;rsepticftank{or seepage pit Qermifited if pubkie sewer is available within 200 feet,) P,ACKAGE TREATMENT [ ]" .SE-PJJC TANK [I Size:._ E - - = -;-- Liquid Depth--------------------------- ' ,T e Material —=- —_No._Compartments.---- ---- ---- --:---:-- --- s Capacity------- = YP . � .Distance'to nearest:1Nell._.----- ----- ------=--------------- length._-_ ----- =--- Foundation_:__ _:.__ -- Prop. Line.--------------=:--=- i INE: No. of:Liraes„:: ..: . :.. : :::.Length o. Total Length..._.,__ -- N - e -LE [- t *” ------ - ---------------------- --- ACHING L � 'D' Box------._.--_Type Filter Material--._.-"-------------Depth Filter Material_.;__._._..__ , s ;--- y- rn ePrope Distanceflr st: Wel!_. ---- --.:_ -.Foundation -- ----' R«k F'llet Yes N #t E]SEEPAGE PIT Depth -._-.Diameter ..._. _ "-Number_` ------------------- Rock - ------ Rock 5izeN Water. Table Depth-- ---- ---- ----- restWFoundationfY :- - .... ine.. - --- Distance.to-nea .- Pr . C. Date _' - ------.---- REPAIR/ADDITION.{Prey: Sanitation Perm it#_.__'--------------------------------- --------------------------- Y ; •: --------- ----------=--------' ,.- -, -------- - Septic Tank (Specify Requirements)___.:.__��.._�___.-,--,_ _ ----------- -- i Disposal Field (Specify Requirements)___- !�cr[- .... 2 J --� 4 �` x1_o-...s --------- ------- - ------- - --------- ------------ ------------ --------- L -- - _ - t ``= -t`- ------ ----------- ---- -- ----- -------- ---------------------- ----------------------------- g a , F � red this application and that the work -on reverse side] � s (Draw exlstin and required add'i I hereby certify that i have,prepa pp. k will be done in accordance with San Joaquin County i the. San Joaquin Local Health District. Home owner or licensed. agents Ordinances, State Caws, arid-Rules and Regulations of signature certifies the following: z = "1 certify that iri 'the performance of the work for whish this permit is issued, 1 shall'not employ any person in such manner as r to become subject to Workman's Compensation lawsof`Califrnia. Signed - Owner . gT ---- - ------ -� �-- - --- Title -- - -- - - [ (I other than owner) t i FOR DEPARTMENT'USE ONLY' �--- DATE.:. APPLICATION ACCEPTED BY__' - ...... . ------------ ------------ .. DATE._.: DIVISION OF LAND NUMB --- -- ------------- _ . -- --- . - .-• ,�----- ------- - ADDITIONAL COMMENTS----------- -- -------------------- --------- --------------------------------- ----------------------------------------------------- . ------ ----- ------------------------------------ ------------------------------- • # Date Final kns ection b �� ------------------------- ------ - - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fat 21617 REV. 7176 3M